Episode 26: Summer Book Club - The Ghost Map, Part 1

As part of the podcast series Solutions for Higher Education, SUU President Scott L Wyatt will lead a “Summer Reading Club” focusing on a new book each month. Readers who join the podcast will be given an introduction to the book by Scott Wyatt and podcast host Steve Meredith near the beginning of each month, and then near the end of the month, an expert guest will join the conversation to give additional insight and context to the completed reading.

The Ghost Map: The Story of London’s Most Terrifying Epidemic - and How it Changed Science, Cities and the Modern World by Steven Johnson
In the middle 1800s London was emerging as a modern city, but it lacked most of the sanitation that we take for granted. In 1854, the city was in the grip of its second outbreak of cholera in less than 10 years. With a combined death toll nearing 100,000, the citizens turned to modern science for answers. Unfortunately, the science of the day dictated that the outbreak be treated as though the disease were airborne, and any efforts to seek other explanations were met with reactions ranging from skepticism to anger. Undaunted, early epidemiologist, Dr. John Snow and local priest, Henry Whitehead began interviewing residents of the SoHo area to see if they could discover the cause of infection and the way in which the contagion spread. The Ghost Map is an intriguing, historical detective novel, and serves as an example that history’s greatest discoveries have often been made by those who refused to accept the conventional wisdom of their day.

Full Transcript

Steve Meredith: Hi again everyone, and welcome to Solutions for Higher Education, a podcast featuring Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. I'm your host, Steve Meredith, and joining me in-studio today, as he always does, is President Wyatt. Good morning, Scott.

Scott Wyatt: Good morning, Steve.  

Meredith: I'm particularly excited for this, our third installment in our summer book club. We're going to be reading a book called The Ghost Map and we have a special guest here to help us introduce that. Will you take a few minutes and introduce our guest?

Wyatt: Yeah. So we're joined by Dr. Dave Blodgett. It's nice to have you with us here today.

Dr. Dave Blodgett: Thanks for having me, it's great to be here.

Wyatt: So I read this book, Dr. Blodgett, because you told me to.

Blodgett: [Laughs] Somebody did something I said? That's good.

Wyatt: It's amazing, isn't it? [All laugh] As a doctor, you think that people are always ignoring your advice.

Blodgett: Yeah, that seems to be pretty routine. [Laughter]

Wyatt: Well let's give you just a minute to introduce yourself. You're a physician?

Blodgett: That's correct.

Wyatt: And you're in public health?

Blodgett: That's right, so I'm kind of a rarity. There's a specialty, actually, in medicine. You can be board certified, like I am, in preventive medicine which is the science of keeping people healthy instead of waiting for them to get sick. So I now serve as the health officer for the southwest corner of the state of Utah as an administrative position, but our job in public health is to do all those little things which help keep the people that we serve in our communities health and create an environment in which health can thrive and people can lead healthy, better lives. So, promote wellness, protect health.

Wyatt: Immunizations and food handling…

Blodgett: Sure.

Wyatt: And just a whole list.

Blodgett: 138 programs. [Laughs]

Wyatt: 138.

Blodgett: And it seems to always be our deal if somebody's not healthy, which is good. So we end up in some surprising areas and we're in the news a lot because there's a lot going on. But most of the time, when we do our best work, you don't hear about it, right? [All laugh] So nobody came up to me and thanked me today that they ate at the restaurant and didn't get sick.

Wyatt: You know, I have been in a lot of countries when I've thought, "I'm really happy about food handler's permits." [All laugh]

Blodgett: That's right. And you know, there's a famous quote in public health that "The difference between a first world and a third world country is public health." [Laughs]

Wyatt: Well, this book, The Ghost Map by Steven Johnson is a fascinating book for a whole bunch of reasons. And I read it because you told me that it gave the story of the start of public health. Why don't you kind of lead us into that story?

Blodgett: OK, excellent lead in. So there is a hero in public health, kind of began the science of what we call epidemiology, his name was John Snow. He was not just famous for his work with cholera, which this story is about, but he also was a very famous anesthesiologist—he was the first anesthesiologist to administer anesthesia to royalty, he did it to the queen. He was kind of a polymath in a lot of ways. He was very well versed in many areas of the world. He died very young, but left a sizeable footprint on the world that came after him, and this is the story of his interest and fascination with the spread of disease and his battle to establish the newly emerging science or thought that there were germs causing disease, rather than miasma, that was behind a lot of what the disease process that they were seeing in medicine. It was quite a battle—all ideas die hard—and the miasma idea took a long time to die, largely because it was so entrenched in the thought process of medieval Europe, and the attempt to come out of that is part of the story that The Ghost Map presents.

Wyatt: And miasma is poison air, right?

Blodgett: Right.

Wyatt: So, "I'm sick because the air is poisoned so I've got to get rid of all these…I've got to take all of these germs and get them into the river and get them away from me so that they air can clean out."

Blodgett: Yes, that is exactly right. Well, so it wasn't that anything was causing it other than what was in the air itself. So I you breathed in "bad air" then that was what made you sick. So it was a very convenient explanation for why some people got sick and other people didn't get sick, why it tended to be people that were living in closely crowded, squalid conditions where things might smell worse would get sick where somebody living in a bigger space had more money. It became a way to classify society, it became a way to…it seemed to fit a lot of the observations that people had about disease until you really looked very closely at what they were saying.

Wyatt: So one of the interesting things that I found with John Snow was, as you mentioned, he was a famous anesthesiologist to serve the queen, thought of very highly, and here's a guy that risked his career to go against the weight of science and medicine—all of the thinking of the day—and say, "You're all wrong, and I'm going to prove you wrong." That seems to be a great risk.

Blodgett: Absolutely. Not even just that, but it required a tremendous personal sacrifice and risk as well. So he took the water. He was there with the people, he knocked on their homes. If the miasma theory was true, then he would have died along with everybody else, right?

Wyatt: Yep.

Blodgett: So in this particular epidemic that is described in The Ghost Map in 1854, somewhere in the neighborhood of 700 to 1000 people died in that immediate vicinity. And for those that didn't understand disease very well, or germs, that was a very scary thing. The guy next to you was dying, didn't know why, and the disease in question, cholera, is a terrible disease. Essentially, you get diarrhea so bad that you lose all of the fluids and electrolytes in your body and die from that. So, terrible way to die. Medical science of the time said, "No, the way you treat this is by withholding water"—which is the exact opposite of the way you do treat cholera now in which you give them water and electrolytes—and so it was all set up to be quite a quagmire. And yet, into that fray, John Snow and perhaps the other protagonist of the book if you want to call him that, Henry Whitehead, they were willing to go in and put their lives as well as their reputations on the line. And the result was the emergence of a new field and a new science. I'm grateful for that example.

Wyatt: So, tell us more about Henry Whitehead.

Blodgett: He was a local pastor—knew the people very well, very involved in people's lives—he started to think, "You know, there's something behind this that we need to find out." So he kind of independently of Dr. Snow went in and started interviewing families and trying to help out where he could and started…he did actually a lot of the good work in documenting who was sick and all the things that happened. So between the two of them—we don't know if they ever met, the book doesn't detail that—but between the two of them, they created this picture of what was going on with a disease that even now people study as kind of a hallmark of good, clear scientific thought.

Wyatt: You know, you talked about these two men…so we're really discussing an outbreak of cholera in London in 1854. We came to find out that it started at the Broad Street well, but at the time, they didn't know that.

Blodgett: Yes.

Wyatt: They just thought that it was poison air. And we've got some of these people that are doing this great investigation work. And I started reading this book because you told me this would be a fun story to read about the origin of public health, which is fascinating, but what really hooked me on this book was this great detective story.

Blodgett: Yeah.

Wyatt: I mean, these guys took great risk, they did such creative, interesting things to discover this cause that flew in the face of reason.

Blodgett: Well, and I think that you and I have discussed the face that one of the great messages from The Ghost Map is just because a lot of people believe it, or because we've always done it that way, doesn't mean that it's not incredibly stupid. [All laugh] So I love that core that comes out in this. This check of, man, sometimes you need to be humble enough to say, "I don't think really know what the real answer is here, and we need to do the work to figure out what it is."

Wyatt: Yeah. We spend our whole lives thinking that this is a problem, poison air, and we fight against that and we realize sometime down the road that we weren't even in the ballpark of the issue. In fact, by trying to solve miasma, we learn in the book, they made it worse, didn't they?

Blodgett: Absolutely, absolutely.

Wyatt: Hugely worse.

Blodgett: They dumped all the…the sewer was all dumped into the Thames River, into the water, and then they'd pull the water back out to drink. So you have these waves of cholera that go through London in the 1800s.

Wyatt: One of the side benefits of reading this story is that I've talked about this with my colleagues at the university and my family and other friends to say, you know, "What are our assumptions? And do we know that they're right?" Because we've all got something that we're pursuing that may not be accurate. How entrenched are we?

Blodgett: Yeah, absolutely. And maybe the interest is a good example of that. You can find all kinds of examples of bad examples on the internet of things that people really, firmly believe and sometimes we believe if enough people say it, it must be true. And I don't think that's the scientific process nor good reason. So I like the check that this book provides for them.

Wyatt: Well, later in the month at the end of this month, we will get together again and talk about the book from the conclusion so that we don't just give away the really fund end to this story. But the reason why someone should read this book—it is the story of the beginning of public health, which is such a big part of our lives right now. It's also a great detective story. It's also a story that helps us think through our assumptions about life generally. Is there any other reason why somebody should read this?

Blodgett: There's some challenges to some premises of society and some conclusions about the world we live in that I think are interesting to me at the end of the book.

Wyatt: Yeah.

Blodgett: And I'm not sure I agree with all of the premises there, but I think it's some challenging thoughts that need to be looked at.

Wyatt: Yeah, so you're referring to the last little bit when they story's done and he kind of gives some of his thoughts.

Blodgett: Yeah, he says, "Look, we want to live in cities, we've decided to live in cities, but what does it take to make sure that's a safe activity? And can we sustain that?" It's an interesting question.

Wyatt: Yeah. You mentioned before we went on the air an analogy or a story from Iron County.

Blodgett: Yeah. So this idea that getting rid of the miasma would be hard or easy is one that I've thought about quite a bit. We tend to look at the world historically through our eyes, and then we say, "Wow, I don't see how that would have been such a problem." But then when you try and put yourself in the situation they were in…so I found from the minutes of the Iron County court in 1905…

Wyatt: [Laughs] The Iron County court?

Blodgett: The Iron County court. So there's two characters involved here: Dr. George Middleton, he's the city physician and health officer as well as the mayor, and Judge Herbert Adams. So let me just read this to you and then maybe have a note. So Herbert Adams was appointed Justice of the Peace in the Cedar precinct, and the following is one of Justice Adams' notable cases. Dr. George Middleton, city physician, instituted proceedings against certain sheep men who ranged their herds in Coal Creek Canyon that were polluting the city's water supply—all of the water was taken out of Coal Creek at that time—the whole case rested upon the germ theory of sanitary pollution and the doctor's expert evidence was holding on this point. Suddenly, Judge Adams broke in with a question:

Judge: Doc, what is a germ?
Doctor: Germs are minute, living organisms of animal or insect life of microscopic size.
Judge: Doctor, have you ever seen a germ with your own eyes? [All laugh]
Doctor: 'Yes, through a microscope, I have' says the doctor.
Judge: Why haven't you put some of those animals here before the court as an exhibit in this case?
Doctor: Your Honor, Judge, they are too small to be seen with the naked eye and the court has no microscope. If Your Honor desires, I can bring my microscope and slides from my office.
Judge: You mean, doc, that they can't be seen by the naked eye or with common reading glasses?
Doctor: Yes, Your Honor. They are too small for that.
Judge: Anything that is too small to be seen by the naked eye is too small for this court to waste its time on. [All laugh] Doc, you show me a germ and I will eat it. Case dismissed.

[All laugh]

Wyatt: Oh my gosh, that is hilarious.

Blodgett: So even in 1905, we were having problems here trying to clean up the water supply because the germ theory was hard to people to grasp.

Wyatt: Because you can't see it with common reading glasses.

Blodgett: That's right. [Laughs]

Wyatt: Well, these things take time, don't they?

Blodgett: Absolutely.

Wyatt: The whole evolution of medical thought is interesting.

Blodgett: Well, and we're doing that in a number of areas even as we speak. And we tend to think, "Well that was…those were barbarians compared to where we're at now." But there's just a number of areas where you look at and you say, "Man, we're having the same struggle as we speak right now." Let me give you just a brief example. The American Academy of Pediatrics has for many, many years now recommended that ear infections not be treated with antibiotics because they don't do any good—98% of them are viral—and yet, for ear infection, antibiotics are prescribed about 80% of the time. [Laughter] So it's a smaller example, but it's the exact same thing. We just have a hard time sometimes embracing what the science tells us and moving on to the next step.

Wyatt: And it's constantly evolving.

Blodgett: Absolutely, absolutely.

Wyatt: Well thank you very much. I read this book thinking this would be interesting, but I discovered that this is one of the most fascinating stories I've read. Such an interesting, compelling and a page turner. It's a real page turner.

Blodgett: Good. Well, I'm glad that you enjoyed it and it would be wonderful if many people would understand a little better what I do, but also understand how public health impacts their life.

Wyatt: Well, I'm looking forward to getting back and talking about what The Ghost Map is.

Blodgett: OK.

Wyatt: We don't want to spoil that.

Meredith: Right.

Blodgett: OK. We'll keep it on the edge. [Laughs]

Wyatt: Because that's…there's got to be something to bring everybody in and the ghost map is it. 

Blodgett: OK, we'll look forward to that.

Meredith: You've been listening to Solutions for Higher Education, a podcast by Scott L Wyatt, the president of Southern Utah University in Cedar City, Utah. We've had as our in-studio guest today Dr. David Blodgett and we've been discussing the book The Ghost Map by Steven Johnson. We're going to be reading that book during the month of August and we hope that you'll join us for the reading and also join us for the recap at the end of the month. We'll be back again soon. Thanks so much for listening, bye bye.